Gay, lesbian, and bisexual youth are at risk for a variety of clinical problems amenable to psychotherapeutic intervention. However, many psychotherapists may be unaware of the difficulties faced by this population. The purpose of this article is to familiarize therapists with presenting complaints common to psychotherapy-seeking gay, lesbian, and bisexual youth. Some of these problems include homophobia among family, peers, and authority figures (often expressed at school or at work), depression, suicidality, social anxiety, and body image disturbance. We illustrate these important issues via four case examples. © 2001 John Wiley & Sons, Inc. J Clin Psychol/In Session 57: 615–627, 2001.